Provider Demographics
NPI:1073891966
Name:ANTHONY, KENNETH J (LMHC, LADC1)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:J
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:LMHC, LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HASELTINE ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7707
Mailing Address - Country:US
Mailing Address - Phone:978-373-3069
Mailing Address - Fax:
Practice Address - Street 1:21 HASELTINE ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-7707
Practice Address - Country:US
Practice Address - Phone:978-373-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS56178134101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)